From the editor: International Women's Day as a vehicle for change

With this issue, Intervention proudly celebrates its 15th anniversary. It is also with great pride that we note that this year, our first issue of the year, is published on International Women's Day. Originally called International Working Women's Day, since its adoption by the United Nations in 1977, each year has had a theme which has been celebrated worldwide with many nongovernmental organisations involved in the celebrations, and through projects.

Intervention is especially proud to highlight and participate in the discussion of this year's theme – International Women's Day as a vehicle for change, is it possible? Looking at most of the environments where we are working, there are certainly changes needed, such as elimination of gender based violence (GBV) and abuse, women and girls enabled to achieve their ambitions without fighting systemic discrimination, both conscious and unconscious bias are challenged, and women and men's contributions to the planet are valued on an equal basis. I am sure that a single day cannot create the widespread changes needed everywhere, but ongoing attention to gender issues (supported by such a day), and the ongoing development and implementation of interventions may definitely lead to the change we all desire. A lot has been done within our field and is still ongoing: research, resources, shared experience, guidelines and information relating to prevention and response to GBV and treatment and support to women in creating a more gender equal environment.

Current affairs

Therefore, Intervention, presents two papers that highlight interventions in which women and girls, who have been exposed to GBV have been supported in our Current affairs section in order to highlight these issues for International Women's Day. The first one is a field report by Guragain & Ghimire, called the ‘Importance of supporting victims through a mental health and psychosocial support lens to ensure justice’. Not only does it contribute to the spotlight on GBV and support for change, it is also continuation of the theme from our previous issue on mainstreaming mental health and psychosocial support into other sectors. This paper shows that it is not easy for women and girls who have faced sexual violence to seek justice. Women and girls need both social and psychological support to cope with the pressure of dealing with the court system and their personal, often confusing, feelings.

The second contribution in Current affairs continues the theme of supporting women and girls in the aftermath of GBV and sexual GBV in a personal reflection by Mogga. She works as coordinator for an emergency programme in refugee camps in northern Uganda. Worryingly, almost 95% of the new refugees are women and children, fleeing from a conflict marked by extensive sexual violence. Her contribution also shows that domestic violence, often culturally sanctioned, creates as much, or even more suffering for these women. She describes an intervention in which they support this refugee population of primarily women and girls.

Both examples show the importance and the value of supporting the women who are suffering from the aftermath of (sexual) gender based violence, which is very important. However, I would plead for more involvement of men in trying to reduce gender based violence. I hope that we can shift the focus from supporting the victims or survivors after, often traumatic, experiences, to interventions and approaches that focus on the interaction between men and women, especially in cases of domestic violence, as prevention. Domestic violence is an exceedingly harmful form of interaction between couples. Last year, I saw interventions in which people become aware of their cultural and unconsciously harmful gender ideas and behaviours, and this can have very successful results. Therefore, these forms of interventions might be a pathway to prevent domestic violence and thereby create a vehicle for change, not only for the couple, but also for their children and their future.

Articles

Our peer reviewed article section offers a host of interesting subjects, and covers a wide range of geographic areas in this well packed issue. Cherepanov addresses the Ethics for global mental health specialists. International mental health providers often work in the settings with complex needs where they are confronted with mass trauma and human suffering. She argues that, in responding to humanitarian psychosocial need, we often need to be able to pass through ethical and moral challenges. Our humanitarian principles and strategic guidelines for psychosocial intervention offer the conceptual framework and operational guidance. She stresses that working in this field require high standards for self-awareness and self-care.

El-Khani, Ulph, Peters & Calam, and their paper Syria: coping mechanisms utilised by displaced refugee parents caring for their children in pre-resettlement contexts continues the work initially presented in issue 14.2. Whereas in the previous article, the emphasis was on the challenges that parents experience in caring and parenting their children within a refugee setting, the current article address the coping skills of Syrian mothers within refugee settings. Three themes were dominant: 1) adaption to a new norm; 2) reaching out for support; and 3) keeping mentally strong. These two studies show the urgency of the need to improve the support for parents in emergency and refugee settings.

Karageorge, Rhodes, Gray & Papadopoulos performed a qualitative systematic review on refugee and staff experiences of psychotherapeutic services. They focussed on client and provider experiences of psychotherapeutic services; combining thematic synthesis and meta-ethnographic approaches. They found that, although practical assistance and advocacy are considered as important to refugees, aspects of care should be part of therapeutic processes of mutual understanding, narrative continuity and self-empowerment.

Field report

The field report of van der Veer can be read as additional information to the article of Guthie (issue 14.1) on Single Session Therapy. This field report addresses Training counsellors in low and middle income countries in single session counselling: helping mental health and psychosocial workers to get on top of feelings of powerlessness. The author describes a systematic, practical, training based approach to help people who have become stuck in their problems and might benefit from a single session of counselling. As such, it helps mental health and psychosocial support workers to offer support in situations where they could easily feel desperate.

Personal reflection

Finally, in his personal reflection, Ganesan describes the process of transforming an out-of-date psychiatric hospital into a patient friendly space. He shows that it is a matter of taking risks and by empowering patients and staff members to change the attitude and behaviour of both groups, he has been able to achieve change in a century old hospital.

CURRENT AFFAIRS

Importance of supporting survivors through a mental health and psychosocial support lens to ensure justice: a case study of girls who were raped and abused in a childcare home in Nepal

Abstract: This field report from Nepal highlights the importance of mental health and psychosocial support in ensuring justice for survivors of sexual violence and abuse. It solidifies how psychosocial support can help to improve the low rate of reporting of sexual violence and lead to higher rates of convictions of perpetrators. The Centre for Victims of Torture Nepal has supported more than 150 survivors of torture, conflict and rape to receive justice in the courts through a holistic approach with mental health and psychosocial support at its core. The organisation is presently pursuing four new cases of child sexual abuse, occurring after the 25 April 2015 earthquake, with a similar approach. Challenges remain in providing justice to survivors of violence, but supporting the survivors through a mental health and psychosocial support lens helps to mitigate these challenges, as highlighted by this case study.

Addressing gender based violence and psychosocial support among South Sudanese refugee settlements in northern Uganda

Abstract: This personal reflection describes how the nongovernmental organisation, TPO Uganda, tried to expand an existing programme providing psychosocial support to survivors of sexual gender based violence in refugee camps in Adjumani District to Bidibidi in Yumbe District, Uganda with an enormous group of new refugees from South Sudan. It describes the kind of (sexual) gender based violence the refugee girls and women experience, how staff try to find these women and provide support through using cognitive behavioural treatment therapy for trauma intervention. The author gives voice to the women who went through this intervention and shows the challenges staff experience in supporting new resettlements of more than 200,000 people since opening in August 2016.

ARTICLES

Ethics for global mental health specialists

Abstract: Global mental health work is an emerging specialisation that focuses on serving culturally diverse populations around the world. International mental health providers often work in the settings with complex needs where they are confronted with mass trauma and human suffering. This places special demands on making independent, responsible, competent and ethical decisions in often unique circumstances. Exposure to both the incomprehensible failure of humanity and the incredible resilience of impacted populations forces professionals to re-examine their convictions and beliefs. This, in turn, opens an opportunity for profound existential discoveries about the world, their profession and themselves. This paper argues that humanitarian principles and strategic guidelines for psychosocial intervention provides the conceptual framework and operational guidance for mental health specialists to navigate ethical and moral conundrums in response to pressing humanitarian psychosocial needs, and to do this in a moral, professional, consistent and collaborative way. Further, serving vulnerable populations calls for higher standards of self-awareness and self-care ( Williams, 2012 ), with safety an imperative and burnout prevention key to professional competencies.

Syria: coping mechanisms utilised by displaced refugee parents caring for their children in pre-resettlement contexts

Abstract: Evidence shows an increased risk of psychological distress and mental health problems in refugee populations. Despite this, refugees often display the ability to continue to function, to recover and live meaningful and productive lives. Parents’ mental health and coping style is significant to the mental health and wellbeing of their children. The aim of this study was to explore the coping mechanisms utilised by displaced Syrian refugees who care for children. Twenty-seven mothers and two professional aid workers in refugee camps and humanitarian contexts in Turkey and Syria participated in interviews or focus groups. Data were analysed using thematic analysis. Data were structured into three themes: adaptation to a new norm, such as acceptance, normalisation and gratitude; reaching out for support, such as in aiding problem solving and gaining support; keeping mentally strong using faith to soothe pain and to motivate to parent well. A number of themes associated with Syrian refugee coping during pre-resettlement were identified. These themes may be translated into strategies to improve culturally appropriate psychosocial interventions in such settings.

Abstract: While the need for psychotherapeutic services for refugees is well documented, little is known about the acceptability and validity of these approaches, especially from refugee and staff perspectives. Qualitative studies of user experience provide critical insight into the utility of current service approaches, and is both clinically and ethically indicated. Therefore, a systematic review of client and provider experiences of psychotherapeutic services is presented (11 studies), combining thematic synthesis and meta-ethnographic approaches. Key concepts to achieving acceptable care were: mutual understanding, addressing complex needs, discussing trauma and cultural competence. Each concept was enabled, or hindered, by a set of related themes. Results found that while practical assistance and advocacy are important to refugee clients, these aspects of care should remain rooted in therapeutic processes of mutual understanding, narrative continuity and self-empowerment through self-efficacy. Further, more ethically rigorous research is still needed in this critical area.

FIELD REPORTS

Training counsellors in low and middle income countries in single session counselling: helping mental health and psychosocial workers to get on top of feelings of powerlessness

Abstract: This article describes an approach to training mental health and psychosocial support workers in post disaster areas and areas of armed conflict in single session counselling, also known as Single Session Therapy. This field report also adds further information to earlier publications on the reasons for practicing Single Session Therapy. The training here described offers the participants a systematic approach, as well as a theoretical explanation of the interdependency of three core activities of a Single Session Therapy therapist: offering recognition, psycho-education and reframing. Single Session Therapy is not only helpful for mental health and psychosocial support workers as it can be effective in restarting the development of people who have become stuck in their problems. Practicing the approach also helps workers make the best of desperate situations and enable them to continue when surrounded by hopelessness. Thus, providing training in Single Session Therapy can also work as a form of staff care.

REFLECTIONS, COMMENTS, LETTERS

Transforming an out-of-date psychiatric hospital into a patient friendly space: a matter of taking risks

Abstract: The author describes his experience as a psychiatrist in a large psychiatric hospital near Colombo, the capital of Sri Lanka. While there, he attempted to transform the wards under his supervision into patient friendly spaces through empowering both patients and staff members. This personal reflection shows that sometimes it can be wise not to have a plan, but to make use of opportunities as they arise.